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Addison's disease
or cortisone and the mineralcorticoids like aldosterone are produced by the outer, or cortex area (shown at right).]] Addison's disease, also known as hypoadrenocorticism, is a chronic condition in which the adrenal glands produce insufficient cortisol. It is the opposite of Cushing's disease, where too much cortisol is produced. The adrenal glands produce two types of hormones; we're most familiar with the glucocortoid ones, such as cortisone. Cortisol and other hormonal levels rise during anger or fear, stress or injury. The term "getting one's adrenalin going" in response to these situations applies to the natural response a healthy body has to them. Those with faulty adrenal glands don't produce enough cortisol to allow the body to respond properly. The other adrenal hormones, known as mineralcorticoids, are what keeps the system in balance regarding proper amounts of salt, potassium, and water in the body. Imbalances of these keys to life can have grave consequences also. As in diabetes, the problem is not enough--not enough of the hormones the adrenal glands produce necessary for proper bodily function. Also like diabetes, Addison's is an endocrine disease, and its sufferers are at risk of developing neuropathy and some eye-related diseases. Symptoms Addison's Disease in Dogs The symptoms range from poor appetite, lethargy. weight loss, and can include shaking and/or shivering, polyuria, hypoglycemia, diarrhea, and vomiting. They are not always specific. Many are similar to those of other diseases, and are the reason why Addison's is known as "The Great Mimic" or "The Great Imitator". Untreated Addison's disease, like untreated diabetes, can be fatal. It is also like diabetes in the respect that the disease is often well-advanced by the time symptoms occur. It is possible to see no symptoms of Addison's disease until 90% of the adrenal cortex is no longer functioning. Causes The cause(s) of Addison's are not always clear--most are attributed to an overactive immune system or are simply idiopathic--no cause able to be found. Addison's can result when there has been long-term steroid therapy and the medication is suddenly stopped. Use of steroids means that the adrenal glands do not function fully during the course of the medication. The body senses the levels of the exogenous steroids in the system and therefore does not signal for additional production of it. During this time, the adrenal glands go into a type of "hibernation" because the steroid medication is literally doing their work for them. In pets and people, the usual protocol for stopping steroid medications is not to eliminate them suddenly, but to withdraw from them gradually in a "tapering off" process. Doses become less and less frequent prior to the planned cessation of the medication. This tells the body to signal the "hibernating" adrenal glands that it's time to go back to producing adrenal hormones. Simply put, the "sleeping" adrenal glands are not able to be "awakened" in cases like this, and the body will need to have its adrenal glucocorticoid hormones replaced by medication; the mineralcorticoids are not affected by this and do not need replacement therapy. There are times when the adrenal glands must either be removed or made to stop functioning with medication. This is sometimes neccessary in the treatment of Cushing's disease, which occurs when the adrenal glands are overactive. The loss of the adrenal glands means that the patient now has Addison's disease and must take medication to replace the hormones the adrenal glands formerly supplied. Typical and atypical Addison's The adrenal outer layer, or cortex, has three layers; each produces a specific type of steroid. In typical Addison's, all of these layers stop functioning; the problem is with the adrenal gland. But in atypical Addison's, the problem is not in the adrenal gland but in the pituitary gland. The gland produces a hormone, ACTH, (adrenocorticotropic hormone), that signals the Zona fasciculata and Zona reticularis to produce their steroids. When the pituitary is unable to produce ACTH, there is nothing to activate the Zona fasciculata and Zona reticularis and they stop production of their respective hormones. The Zona glomerulosa remains able to produce a normal amount of mineralcorticoids because it is not controlled by ACTH. An atypical Addison's patient does not face the risk of an Addisonian crisis and only needs to have medication to replace the glucocorticoid steroid cortisol. In some dogs with atypical (secondary) Addison's, the disease progresses to the point where mineralcorticoid replacement is necessary (making them typical or primary Addison's patients), while others retain their ability to continue production of mineralcorticoids for years, requiring glucocorticoid replacement only. False test reports Dog breeds whose origin is in the Pacific Rim, such as the Akita, normally have elevated potassium levels found during blood testing; ACTH testing results should be within normal ranges if the patient does not have Addison''s. Whipworm infections can produce a syndrome that appears to be an Addisonian crisis. Just as with Addison's, blood tests will also show abnormalities in sodium and potassium levels. ATCH testing will be within normal ranges. Treatment Diagnosis is through testing, with ACTH testing being the gold standard. Treatment is by replacing or augmenting the insufficient or absent hormones. Addison's disease patients will need this treatment for the rest of their lives and can lead normal ones, as long as they are given proper treatment for their deficiency. Dogs with diagnosed and treated diabetes but undiagnosed/untreated Addison's disease may have reduced insulin needs. Here's help-message boards and e-mail lists *K9 Addisons Mailing List-Help & Support *Addisondogs.com-Support and Discussion of Canine Addison's Disease References More Information * Diagnosis and Treatment of Canine Addison's--Treating Addisonian Crisis Southpaws * Canine Addison's Disease and its treatment Brooks, Wendy C., Veterinary Partner *Introduction to Canine Hypoadrenocorticism (Addison's Disease) Dixon, Richard, Axiom Vet Laboratories UK *Emergency Therapy for Dogs-Acute Addisonian (Hypoadrenocorticism) Crisis McGrotty, Yvonne, Axiom Vet Laboratories UK *Addison's Disease: Helpful Links Page Beacon for Health *Addison's Disease Mirage Samoyeds *Use of Basal Plasma Concentrations to Rule Out a Diagnosis of Hypoadrenocorticism in Dogs ACVIM, 2006-Page 25, Abstract #68 *Glucocortoid Deficient Hypoadrenocorticism More Prevalent than Previously Believed ACVIM, 2006-Page 25, Abstract #69 *Hypoadrenocorticism in 98 Dogs ACVIM, 2006-Page 79, Abstract #229 *Symptoms, Testing & Treatment of Addison's Disease PetsHealth *More on Diagnosing Addison's PetsHealth *Recognizing & Treating Addison's Disease Mooney, Carmel T., WSAVA, 2003 *Gastrointestinal Signs in Endocrine Disorders of Cats & Dogs Provet UK *Addison's Disease-Hypoadrenocorticism Drs. Foster & Smith Pet Education Library *Addison's Disease Marvista Vet *Low Sodium: Potassium Ratios in Dogs and Cats Charles, J. A., WSAVA, 2003 *Fluid and electrolyte therapy in endocrine disorders: diabetes mellitus and hypoadrenocorticism Veterinary Clinics of North America, 2008 *Addison's Disease Antech Diagnostics *Basal Cortisol Concentrations for Assessing Adrenal Function Antech Diagnostics *Addison's Disease in Standard Poodles North American Veterinary Conference, 2003 *Hypokalemic Myopathy in a Dogs with Addison's Disease NAVC, February 2008 *Testing for Addison's Disease Hoskins, Johnny D., DVM 360, January 2009 *Basal circulating cortisol concentrations and hypoadrenocorticism DVM 360, 2009 *Endocrine Emergencies Wallace, Melissa S., 2001, Atlantic Coast Veterinary Conference *Ocular Manifestations of Systemic Disease in Small Animals Dennis E. Brooks, University of Florida School of Veterinary Medicine Category:Conditions Category:Complications Category:Other conditions and procedures Category:Content